Emergency department physicians take steps to prevent burnout
Posted April 13, 2011
What began as a journal club discussion of physician burnout in the UC Davis Department of Emergency Medicine has evolved into a well-developed system for addressing the problem, featuring tactics such as forming pairs to provide mutual support in developing personal plans to reduce stress, and identifying and dealing with systemic sources of stress in the department.
While the project has not eliminated all sources of stress in the department, it initiated an important discussion about physician burnout and is a significant step toward enhancing awareness of the issue and emphasizing the importance of physicians caring for each other.
"In a profession whose calling is taking care of others, it is essential but can be difficult to create time and space to care for one's self," said Garen Wintemute, professor of emergency medicine and faculty development director for the emergency department. "Yet, ironically, to ignore this aspect of life can make excelling and thriving less likely. ED physicians everyday walk through the ED and use their assessment skills to determine who is in trouble. These are the same assessment skills that can be used to notice how a colleague is doing and to check in with colleagues and with one's self."
Following the journal-club discussion, Wintemute received the enthusiastic go-ahead from Nathan Kuppermann, department chair, to pursue a program of training and self-reflection for the faculty on the health of the department, with a commitment to identifying potential causes of emergency department burnout and support for change.
Burnout rate high among physicians
Burnout is defined as a response to prolonged exposure to demanding interpersonal situations and is characterized by three experiences: feeling emotionally overextended and exhausted by work, expressing a negative and cynical attitude and treating patients as objects, and having a sense of low personal accomplishment. Recognizing burnout is important because of its potential consequences:
|• Poorer patient care, more errors||• Auto accidents||• Lower empathy||• Quitting practice|
|• Poor relaltionships, marital/family stress||• Stress-related health problems||• Substance abuse|
Research indicates that the prevalence of burnout among practicing physicians is 25-60 percent and tends to be caused by such factors as overwork, sleep deprivation, low control/high responsibility, inadequate support, and imbalance between personal and professional life.
Burnout may arise from individual behavior, system demands, and cultural norms and expectations. These are the areas where changes can decrease burnout risk.
Faculty in the Department of Emergency Medicine started their process of learning by taking the Maslach Burnout Inventory — everyone participated during 20 minutes of a faculty meeting. This was followed by a two-hour faculty development mini-retreat. Some faculty members arrived as they came off a shift, others arrived just before starting a shift, and others supported the team by working during the retreat. Although the maneuvering was difficult, the faculty recognized the importance of the project.
During this session, the faculty received information on burnout and healthy ways to cope with stress. Each faculty member received their Maslach Inventory scores. All information was confidential.
The faculty had an animated discussion about burnout stressors. They also talked about healthy ways of coping with stress that promote resiliency and decrease risk of burnout. They included:
- Finding support in the workplace, including identifying good mentoring and setting limits on professional commitments
- Developing and nurturing healthy relationships with friends, family and a supportive partner
- Staying connected to the meaning and joys of work
- Taking time for vacations, exercise and hobbies
Three months later, the department held a second faculty development mini-retreat focusing on making changes to decrease the likelihood of burnout. Although some causes of burnout are not changeable, how a physician responds can make a substantial difference to his or her health and happiness. Consequently, the attendees' first task focused on individual responsibility.
Emergency care at UC Davis
UC Davis operates the largest and busiest emergency department in Sacramento and the only level 1 pediatric and adult trauma center in Northern California.
Expanded in 2010 and named for a leader in orthopaedic and trauma care, the Michael W. Chapman Emergency and Trauma Center's state-of-the-art equipment, large patient-care areas highly skilled medical team give UC Davis the capacity to treat any critical injury or illness. The department provides care for more than 55,000 patients each year. For more information, visit the department’s website.
Teaming up for mutual support
Physicians worked in pairs to support each other in the development of personal action plans to increase well-being. Each person committed to deal with a work stressor in a healthy way. Examples include exercising three times per week, having breakfast with family or putting the kids to bed three times a week, seeing friends once a week, using breathing techniques when stressed, noticing the joys of their ED work and expressing appreciation.
These plans were written down with the specifics of what would be done and taken home to be posted on refrigerators, locker doors, bathroom mirrors and other locations. One month later, faculty members received a copy of their plan, sent to them by the facilitator, as a reminder of their commitment. This offered a moment to reflect on what worked, what didn't, and what's next in taking responsibility to stay healthy.
Second, the group worked to identify a shared stressor and to develop a potential solution to that stressor. The group selected a faculty spokesperson to begin a dialogue with Kuppermann. This dialogue continued with the whole faculty at the annual retreat. There, they focused on creating flexibility regarding time, sharing the load, clarifying expectations for academic success (internal expectations vs. system expectations), and increasing transparency regarding faculty evaluation process.
The faculty and leadership reached agreement about some changes at the retreat, including improving the system for distributing and giving credit for teaching. The department continues to discuss other topics raised throughout the process.
There is general agreement in the department that the outcome was worth the time and effort devoted to it. Faculty now "check in" with one another informally, recognizing that just as risk for burnout never disappears, efforts to prevent and mitigate it must continue as well.